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A Report on Attitudes Towards Family Planning & Family Size in Botswana

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A Report on Attitudes Towards Family Planning & Family Size in Botswana ~'2 A Report on Attitudes towards Family Planning & Family Size in Botswana By Pia du Pradal March 1983 PREFACE The following is a report on a -survey which investigated the atti­ tudes of Batswana men, women and youths to family planning and family size. The research was conducted between September 1981 and May 1982 by the students of the Department of Nursing Education, University of Botswana in conjunction with the Department of Maternal/Child Health and Family Planning, Ministry of Health. The project was funded by the Research Triangle Institute in North Carolina (Sub-Contract No 9-214-1920) and further supported by US AID, Botswana which funded the services of the co-ordinator. I would like to express my sincere thanks to the many people who assisted with this project. Particular mention should be made of Karen B Allen, Dr Ellen Fried and Dr Dennis Chao of RTI who supported the project during its implementation and provided invaluable assis­ tance in the data analysis; Dr Mashalaba of the Department of MCH & FP whose sincere interest in the project stimulated it throughout; Mrs Kupe of the Department of Nursing Education who provided the full support of her faculty; and Mr C Gordon of US AID without whose encouragement the project would never have been implemented. I would also like to thank those students who participated in the project working long hours during weekends and holidays in order to keep the project on schedule and to rectify errors. Finally, I would like to thank Chief Linchwe II for allowing us to conduct this research amongst the Bakgatla and the 826 respondents who answered the questions so explicitly. I hope this report will help the Ministry of Health clear some of their confusion concerning family planning. Special mention should be made of the work conducted by Professor Isaac Schapera some fifty years ago amongst the Bakgatla in Mochudi. This has provided a rich source of information and has frequently been referred to in this document. Pia du Pradal Project Co-ordinator March 1983 TABLE OF CONTENTS 1. INTRODUCTION 1 1.1 Background to the Project 1 1.2 Institutional Involvement 2 1.3 Project Goals 3 2. METHODOLOGY 5 2.1 A Pilot Project? 5 2.2 Target Groups 5 2.3 The Questionnaire 6 2.4 Survey Areas 7 2.5 Sampling Techniques a 2.6 Data ANALYSIS 9 2.7 Workshops 3. THE SURVEY SAMPLE 10 3.1 Area 10 3.2 Age 11 3.3 Education 11 3.4 Marital Status 14 3.5 Economic Status 15 4. IDEAL FAMILY SIZE 16 4.1 No Children or Many Children? 16 4.2 Analysing the Ideal 18 4.3 The Ideal according to the Sex of the Respondent 18 4.4 Ideal Family Size by the Age of the Respondent 18 4.5 Ideal Family Size by Education 19 4.6 Ideal Family Size by Rural & Urban Area 20 4.7 Ideal Family Size by Marital Status 20 4.8 Discussion of Some Factors Dtermining Ideal Family Size 21 5. CHILD MORTALITY 23 6. CHILD SPACING 27 7. CUSTOMARY METHODS OF AVOIDING PREGNANCY 33 8. MODERN CONTRACEPTION 36 8.1 Knowledge and Practice of Contraception 37 8.2 Effect of Age on Knowledge and Use of FP 38 8.3 Effect of Education on Knowledge and Use of FP 41 8.4 Effect of Residential Area on Knowledge and Use of FP 43 8.5 Effect of Marital Status on Kncwledge and Use of FP 46 9. MISCONCEPTIONS AND CONFUSION CONCERNING CONTRACEPTION 47 9.1 The Pill 47 9.2 The IUD 48 9.3 The Condom 49 9.4 The Diaphragm 50 9.5 Sterilization 5) 10. SOME OTHER MISCONCEPTIONS INFLUENCING ATTITUDE TO 51 FAMILY PLANNING 10.1 Frequent Births are Necessary to Cleanse the Womb 51 10.2 Modern Contraception causes Infertility 51 10.3 Women who use FP are Promiscuous 53 11. DISCUSSION OF MALE ATTITUDE TO FAP 54 11.1 Attitude to their Partners Practicing Family Planning 54 11.2 Male Attitude to the Condom 56 11.3 Summary 59 12. 'ILLEGITIMACY' 60 12.1 Unmarried Mothers ( 12.2 Pregnancy Amongst Youths 63 12.3 Some Social Causes of Single Parenthood 66 12.4 'Illegitimacy' - The Problem as Seen by the Respondents 67 12.5 Family Support to Single Mothers 60 12.6 Discussion of Some Social Reasons why Single Women do 69 not Protect Themselves against Pregnancy 12.6.1 The Negative Attitude of Males towards Contraception 69 and Fear of this Breaking their Relationship 12.6.2 The Desire to have a Child to Prove that thay are 69 Fertile and Perhaps to Foster the Relationship 12.6.3 Inhibitions at Obtaining FP from Clinics 72 13. THE NEED FOR EDUCATION ON CONTRACEPTION 74 13.1 Reaching Males 74 13.2 Reaching Youths 75 13.3 Correcting Women 78 14. CONCLUSION 79 LIST OF TABLES TABLE I SURVEY SAMPLE 10 TABLE II RESPONDENTS' AGE 12 (A) ADULTS (B) YOUTHS TABLE III EDUCATIONAL STATUS OF THE RESPONDENTS 13 (A) ADULTS (B) YOUTHS TABLE IV MARITAL STATUS 14 TABLE V ATTITUDE TOWARDS WOMEN WITH NO CHILDREN, 17 FEW CHILDREN AND THE MAXIMUM No POSSIBLE TABLE VI IDEAL FAMILY SIZE BY SEX AND AGE OF 19 RESPONDENT TABLE VII EDUCATION AND IDEAL FAMILY SIZE 19 TABLE VIII A COMPARISON OF ILiAL FAMILY SIZE ACCORDING 20 TO RESIDENTIAL AREA TABLE XIX DISTRIBUTION OF DEATHS PER 100 FAMILIES, 23 1940 AND 1982 COMPARED TABLE X RURAL-URBAN CHILD MORTALITY RATE 24 TABLE XI AGE OF CHILDREN AT DEATH 24 TABLE XII CAUSE OF CHILD MORTALITY 25 TABLE XIII MISCARRIAGES AND STILLBIRTHS 26 TABLE XIV SUMMARY OF DATA ON MALES WHO DO NOT KNOW 30 ABOUT CHILD SPACING TABLE XV ATTITUDE TO CHILD SPACING 31 TABLE XVI THE DESIRED PERIOD BETWEEN CHILDREN 32 TABLE XVII PERCENTAGE OF RESPONDENTS WHO COULD NAME 37 THE METHODS OF FP TABLE XVIII USE OF DIFFERENT METHODS OF CONTRACEPTION 38 TABLE XIX KNOWLEDGE AND USE OF CONTRACEPTION ACCORDING 46 TO MARITAL STATUS TABLE XX ATTITUDE TO 4 MISCONCEPTIONS 52 TABLE XXI MALE ATTITUDE TO PARTNER USING FP 55 \ TABLE XXII ATTITUDE OF MALES TO PARTNER USING FP 57 ACCORDING TO MARITAL STATUS TABLE XXIII SINGLE MOTHERS ACCORDING TO AREA 61 TABLE XXIV EDUCATION OF SINGLE MOTHERS COMPARED 62 WITH OTHER WOMEN TABLE XXV AGE OF SINGLE WOMEN 63 TABLE XXVI EDUCATION OF TEENAGE MOTHERS 64 TABLE XXVII RELATIONSHIP OF SINGLE MOTHERS TO HOUSEHOLD 70 HEA)S TABLE XXVIII THREE BELIEFS AFFECTING ATTITUDE TO FP 71 TABLE XXIX OPINION ON YOUTHS BEING TAUGHT FP, 75 THE APPROPRIATE AGE AND SOURCE OF INFORMATION ABBREVIATIONS AND ANACRONYMS Col - Column CSO - Central Statistics Office, Ministry of Finance and Development Planning Dis - Disagree D/K or D K - Don't Know FP - Family Planning FWE - Family Welfare Educator GOB - Government of Botswana IUD - Inter Uterine Device KAP - Knowledge, Attitude and Practice - Surveys of Kgatla - Root of word referring to tribe; Bakgatle tribe, Mokgatla person, Kgatleng district Kgotla - Tribal council and place where council meets lolwapa - Yard or homestead MCH & FP - Maternal/Child Health and Family Planning Department of MOH - Ministry of Health NIR - National Institute of Research RTI - Research Triangle Institute, North Carolina Sep - Separated, divorced or widowed UB or UBS - University of Botswana, formerly University of Botswana and Swaziland US AID - United States Agency for International Development VD - Venereal Disease 1. INTRODUCTION .1 Background to the Project Surveys of Knowledge, Attitude and Practice (KAP) of family planning are common throughout the world. This type of research is,'however, relatively new to Botswana. Prior to this project, focus has been on the evaluation of the delivery system, rates of acceptance, drop-out levels together with a number of small attitudinal studies. Such research was conducted mainly in clinics with small samples of women. This pilot project was designed to compliment these earlier studies by interviewing Batswana men, women and teenage girls in their homes. In this way it was hoped to overcome the possible bias created by interviews being conducted wit}iin a health facility. It was also thought that in doing this, one would get a more representative sample of the population. Since the family planning programme was introduced in Botswana in 1971 the Ministry of Health has had to deal with it cautiously, integrating it with the Department of Maternal and Child Health and emphasizing child spacing rather than population control. It has nevertheless been the subject of political controversy as the following quotation reveals: "Family Planning in Botswana is taught and practiced as a measure for spacing pregnancies and not as a birth control programme and no mention is ever made of family size. This was said in Parliament by the Minister of Health, Mr L M Makgenene, in reply to a question from the member of Parliament for Kanye South, Mr B S Gaseitsiwe who wanted to know 'what effect and influence the family planning propaganda, introduced many years ago, has had on the birth rate in Botswana.' (He) ... also wanted to know whether it is right for a government of a small population such as Botswana to persuade her people to have fewer children when 'shortage of man­ power is the talk of the day.'" (Botswana Daily News: March 10, 1981, No.45, p.2) - 2 - The few radio programmes dealing with family planning have aroused strong public criticism. Traditionally sexual matters were never discussed in public. Consequently, the more conser­ vative members of society have taken offence and pointed out that such family planning health talks were offensive, despite the fact that the Ministry of Health had taken pains to discuss it as politely as possible.
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